Alzheimers Disease

Nov 25, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I like parades. The Knights of Columbus will be hosting their Annual Christmas Parade of Lights on Saturday, November 29th at 5:30pm. Years ago, I remember walking in the Christmas Parade with the Dauphin Clinic Pharmacy. More recently, I've worked the time clock at hockey tournaments while other people took my kids to the parade. And in the last couple of years, I've handed out hot chocolate with the Kinsmen near the Court House to parade watchers. The Christmas Parade has such a different feel than summer parades. The lighted floats moving down Main Street really are quite beautiful.

It is fun to reminisce about Christmas Parades of Lights past. However, as we age, we all forget things. And it is common to hear people wonder if they have Alzheimer's disease when they forget. They probably don't, but Alzheimer's disease is a serious problem. It will affect Canadians more and more in the coming years. That is because as a nation, we are getting older. In 2011, the first wave of the baby boomers turned 65. There is very little dementia in the population before the age of 65. However, the risk for dementia doubles every five years after age 65.

In 2011, 747,000 Canadians were living with dementia and Alzheimers disease. That is about 15% of Canadians over the age of 65. As the baby boomers age, by 2031 this number will increase to 1.4 million people. Dementia doesn't just affect the person with the disease. One in five Canadians aged 45 and older provides some form of care to seniors living with long-term health problems. In 2011, family caregivers spent in excess of 444 million unpaid hours looking after someone with cognitive impairment, including dementia. This figure represents $11 billion in lost income and 227,760 full-time equivalent employees in the workforce. By 2040, family caregivers will spend a staggering 1.2 billion unpaid hours per year looking after someone with dementia.

Alzheimers disease is the most common form of dementia. It accounts for 64 per cent of all dementias in Canada. Dementia is a condition with symptoms like loss of memory, poor judgment and reasoning, changing moods and change in ability to talk and communicate. Alzheirmers disease was discovered by Dr. Alois Alzheimer in the early 1900s. He found plaques and tangles in the brains of some dementia patients after they died. These are still the hallmarks doctors look for when confirming Alzheimers disease after the death of the patient.

So if I lose my car keys, do I have Alzheimer's? Probably not. Forgetting things occasionally is normal as we age. Dementia and Alzheirmers disease are different than normal forgetting as we age. Forgetting where you put the car keys is probably normal aging. Forgetting how to drive a car might be dementia. Forgetting the name of an acquaintance might be normal aging. Forgetting who your immediate family members are might be dementia. If you are worried about your memory, but your relatives are not, it is probably normal aging. If your relatives are worried about your memory, but you arent aware there is any problem, it might be dementia.

In Alzheimer's disease, brain cells die. This results in of loss of memory and cognitive functioning. One key brain chemical, acetylcholine, appears to be in short supply in Alzheimers disease. Many drugs used to treat Alzheimer's disease are aimed at increasing the amount of acetylcholine in the brain.

Cholinesterase is an enzyme that breaks down acetylcholine. Drugs that inhibit this enzyme will leave more acetylcholine in the brain. The first cholinesterase inhibitor to gain wide scale use in Canada was donepezil or Aricept. We now also have rivastigmine or Exelon and galantamine or Reminyl. All three of these cholinesterase inhibitors are indicated for mild to moderate Alzheimers disease.

Memantine or Ebixa is a little different. It is called an NMDA receptor antagonist. It works on a different brain chemical called glutamate. It is approved for use in moderate to severe Alzheimers and can be used with Aricept.

Here is the bad news. None of these medications is a cure. None of these medications will stop the disease from progressing. The best any of these medications can do is help manage symptoms and help maintain a persons functioning for as long as possible. I see a lot of false hope in the pharmacy that these medications will cure a loved one with Alzheimers. They wont. And these medications are expensive and not always covered by Manitoba Health.

The future for Alzheirmers may be brighter, though. The researchers are learning more about how to prevent the dementia and are working on future treatments. One thing bit of research I found interesting is that preventing concussions and head injuries in the young may help those people to avoid dementia when they are older. And there is research happening today that we hope will produce treatments in 5 to 10 years that may be able to slow and stop the progression of Alzheimers disease.

Come out to the Knights of Columbus Christmas Parade of Lights November 29th. Come see the Kinsmen at the Court House for some hot chocolate. Make some new memories while you enjoy the unofficial start to the holiday season in Dauphin.

For more information see: Alzheimers Society of Canada

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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